title: Management of neglected Blount disease using double corrective tibia osteotomy and medial plateau elevation.
abstract: OBJECTIVE
  A double osteotomy for correcting tibial deformity in combination with medial plateau elevation is recommended for the management of neglected Blount disease cases. We report our clinical experience with the application of this surgical technique and describe the long-term follow-up of the patients who were operated on.
  
  
  METHODS
  During a 10-year period, eight children (8 boys) with mean age of 12 years (range 9-14 years) underwent surgery (9 operations) due to neglected infantile tibia vara. All patients suffered from stage V or VI Blount disease according to the Langenskiold and Riska classification. Two simultaneous combined osteotomies were performed for medial plateau elevation and for correction of the tibial deformity. The correction was immediate using K-wires for stabilization and a long-leg cast for immobilization. The mean duration of follow-up was 10 years (range 5-15 years), and the evaluations were based on clinical and radiological criteria.
  
  
  RESULTS
  At the latest follow-up, there was no observable knee flexion or extension restriction and no signs of instability or lateral thrust. All patients had returned to a higher activity level. Leg-lengthening surgery was performed in one child, but the length discrepancy was already present before the double osteotomy was performed. No other complications were noticed. All the angles measured on X-rays had been corrected, and this correction was retained until the latest follow-up.
  
  
  CONCLUSIONS
  This method results in very good outcomes in patients who suffer from Blount disease of stage V or greater. With this technique, the tibial deformity is corrected, the articular surface is restored, and future recurrence is prevented.
authors.affiliation: 1st Orthopaedic Department, General Children's Hospital "P. & A. Kyriakou", 18 str. Aristophanous, 18533 Piraeus, Athens, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Gkiokas
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Brilakis
keywords: Double osteotomy; Neglected Blount disease; Pediatric knee; Tibia vara; Tibial plateau elevation